Aerobic Exercise in People with Schizophrenia: Neural and Neurocognitive Benefits

Abstract

Schizophrenia is characterized by extensive neurocognitive deficits, which are linked to greater disability, poorer functional outcome, and have been suggested to impact daily functioning more than clinical symptoms. Aerobic exercise (AE) has emerged as a potential intervention. This review examines the impact of AE on brain structure and function along with neurocognitive performance in individuals with schizophrenia. Preliminary evidence indicates that AE can increase hippocampal volume and cortical thickness, in addition to exerting a neuroprotective effect against hippocampal volume decrease and cortical thinning. There is also evidence that AE is able to significantly increase serum brain-derived neurotrophic factor (BDNF) levels, which are implicated in neurogenesis, neuroplasticity, and cognitive improvement. Finally, evidence suggests that AE plays a significant role in improving overall cognition, including improvements in processing speed, working memory, and visual learning. The authors discuss the implications of the findings and provide recommendations for future research and areas of inquiry.

Clozapine and all‐cause mortality in treatment‐resistant schizophrenia: a historical cohort study

“…Some previous studies found the protective effect of clozapine on all‐cause mortality after adjustment of baseline history of cardiovascular disease including ischaemic heart disease . However, after clozapine initiation, the likelihood of having cardiometabolic illnesses such as hypertension, diabetes mellitus and hyperlipidaemia may increase . Because of the cardiovascular adverse effects of the drug, it is possible that clinicians may more strongly advise smoking cessation to clozapine users, with this leading to reduced smoking behaviour .…”

“…Moreover, patients who meet the definition of treatment resistance may be biologically distinct from those with treatment‐responsive schizophrenia . In line with this, two recent studies have investigated the effect of clozapine use on mortality in TRS . The study using United States Medicaid data reported no significant mortality difference between those patients treated with clozapine and those without , whereas the Danish national registry study found an approximately twofold higher mortality in non‐clozapine users .…”

“…In line with this, two recent studies have investigated the effect of clozapine use on mortality in TRS . The study using United States Medicaid data reported no significant mortality difference between those patients treated with clozapine and those without , whereas the Danish national registry study found an approximately twofold higher mortality in non‐clozapine users . Without further study, these contrasting findings from two different healthcare systems make it difficult to determine whether clozapine does or does not reduce the risk of death in patients with treatment‐resistant schizophrenia.…”

Lab-Based and Self-Reported Indices of Fitness Show Lowered Fitness and Insight into Fitness in Individuals at Clinical High Risk for Psychosis

“…Exercise is a promising new area of intervention for individuals across many stages of psychosis, including for those at clinical high risk for psychosis (CHR). [1][2][3][4][5][6][7][8] Despite the benefits of this new area of intervention, substantially less work has examined unique factors of the CHR population that would have bearing on tailoring an effective, early intervention (i.e., understanding characteristic health and starting fitness levels). 7,[9][10][11] Extant research, however, has relied solely on self-report measures of physical activity to assess fitness, 9,10,[12][13][14] with few exceptions.…”

“…A growing body of research has demonstrated that exercise interventions are effective in improving cognitive function 1,4,5,11,19 and neurological function 2,11 for individuals across the psychosis spectrum including, risk mental states, CHR, the first episode of psychosis, and schizophrenia populations. Although existing psychosis literature has established that individuals with psychosis have significantly poorer physical health, 1,6,14,19,20 the evidence regarding the physiological health of individuals at CHR for psychosis is unclear.…”